HomeMy WebLinkAboutRP26-002 Please note that this application must include the notarized signature(s) of the
legal owner(s) of the above-mentioned property, in the space provided below.
Any application not bearing the legal property owner's notarized signature(s)
shall be deemed null and void, and will be returned to the applicant.
STATE O�NEW�YOpRKK,COUNTY OF WESTCHESTER
y ,being duly sworn,deposes and states that he/she is the applicant above named,
(print name of individual siOng as the applicant)
and further states that (s)he is the legal owner of the property to which this application pertains, or that (s)he is the
Contractor for the legal owner and is duly authorized to make and file this application.
(indicate architect,contractor,agent,attorney,etc.)
That all statements contained herein are true to the best of his/her knowledge and belief,and that any work performed,or use
conducted at the above captioned property will be in conformance with the details as set forth and contained in this application
and in any accompanying approved plans and specifications,as well as in accordance with the New York State Uniform Fire
Prevention&Building Code,the Code of the Village of Rye Brook and all other applicable laws,ordinances and regulations.
Sworn to before the this
Sworn to before me this
day of 520 day of C c, 20_,�,C�
/ 5TATL ature of Applicant
Signature of Property Owner _ �'OF NEW YOM PP
t N-TA1t�EI[1C
i LIC"k )0 ] V
Print Name of Property Owner ,- OtpA63"'° �° print Nam t Applicant
Notary Public No Public
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